An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has found many more people have died than previously thought – a total of around 15 million by the end of 2021, more than double the official total of six million reported by individual countries.
But the release of the staggering estimate – the result of more than a year of research and analysis by experts around the world and the most comprehensive examination of the lethality of the pandemic to date – has been delayed by several months due to objections from India, which disputes the calculation of the number of its dead citizens and tried to prevent it from becoming public.
More than a third of the additional nine million deaths are estimated to have occurred in India, where Prime Minister Narendra Modi’s government has maintained its own tally of around 520,000. WHO will show the country’s toll is d ‘At least four million, according to people familiar with the figures who were not authorized to release them, which would give India the highest tally in the world,’ they said. The Times was unable to find out estimates for other countries.
The WHO calculation combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aim to account for missed deaths. Most of the difference in the new global estimate represents previously uncounted deaths, most of which came directly from Covid; the new number also includes indirect deaths, such as those of people unable to access care for other conditions due to the pandemic.
The delay in releasing numbers is significant because global data is key to understanding how the pandemic unfolded and what measures could mitigate a similar crisis in the future. It has created turmoil in the normally staid world of health statistics – a squabble cloaked in innocuous language is playing out at the United Nations Statistical Commission, the global body that collects health data, spurred by the denial of India to cooperate.
“It is important for global accounting and the moral obligation to those who have died, but also very important in practice. If there are subsequent waves, then really understanding the total number of deaths is essential to know if vaccination campaigns work,” said Dr. Prabhat Jha, director of the Center for Global Health Research in Toronto and a member of the expert working group supporting the WHO calculation of excess mortality. “And that’s important for the responsibility.”
To try to take the true measure of the impact of the pandemic, the WHO has brought together a group of specialists including demographers, public health experts, statisticians and data scientists. The Technical Advisory Group, as it is known, has been working across countries to try to piece together the most comprehensive tally of the dead from the pandemic.
The Times spoke to more than 10 people familiar with the data. The WHO had planned to make the figures public in January, but the release has kept coming. pushed back.
Recently, a few members of the group warned the WHO that if the organization did not release the figures, the experts would do so themselves, three people familiar with the matter said.
A WHO spokeswoman, Amna Smailbegovic, told The Times: “We are aiming to publish in April.”
Dr Samira Asma, WHO’s deputy director-general for data, analysis and delivery for impact, which is helping to lead the calculation, said the release of the data had been “slightly delayed”, but said said it was “because we wanted to make sure everyone is consulted.
India insists that the WHO methodology is flawed. “India believes that the process was neither collaborative nor sufficiently representative,” the government said in a statement to the United Nations Statistical Commission in February. He also argued that the process lacked “the scientific rigor and rational scrutiny expected of an organization of the stature of the World Health Organization.”
The New Delhi health ministry did not respond to requests for comment.
India is not alone in undercounting deaths from the pandemic: the new WHO figures also reflect undercounts in other populous countries like Indonesia and Egypt.
Dr Asma noted that many countries have struggled to accurately calculate the impact of the pandemic. Even in the most advanced countries, she said, “I think when you look under the hood, it’s difficult.” At the start of the pandemic, there were significant disparities in how quickly different US states reported deaths, she said, and some were still collecting the data by fax.
India brought a large team to review the analysis of the WHO data, she said, and the agency was happy to have done so, as it wanted the model to be as transparent as possible.
India’s work on vaccination has been praised by experts around the world, but its public health response to Covid has been criticized for being overconfident. Mr Modi vaunted in January 2021 that India had “saved mankind from a great disaster”. A few months later, its Minister of Health declared that the country was “in the final stage of Covid-19.” Complacency has set in, leading to missteps and attempts by officials to silence critical voices within elite institutions.
Science in India has been increasingly politicized during the pandemic. In February, India’s junior health minister criticized a study published in the journal Science who estimated that the country’s Covid death toll was six to seven times the official number. In March, the government questioned the methodology of a study published in The Lancet who put the death toll in India at four million.
“Personally, I’ve always thought science should be answered by science,” said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan’s School of Public Health, who has worked with the WHO to examine the data. “If you have an alternative estimate, which is based on rigorous science, you just have to produce it. You can’t just say, “I’m not going to accept it.”
India has not submitted its total mortality data to the WHO for the past two years, but the organization’s researchers used figures collected from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least four to five times more. deaths due to Covid-19.
Jon Wakefield, a professor of statistics and biostatistics at the University of Washington who played a key role in building the model used for the estimates, said a first presentation of WHO global data was ready in December.
“But India was not happy with the estimates. We then did all kinds of sensitivity analysis, the document is actually much better because of that expectation, because we went too far in terms of model checks and did everything we could given the data available,” says Dr. Wakefield “And we are good to go.”
The figures represent what statisticians and researchers call “excess mortality” – the difference between all deaths that have occurred and those that should have occurred under normal circumstances. WHO calculations include those deaths directly from Covid, deaths of people from conditions complicated by Covid and deaths of those who did not have Covid but needed treatment they could not get because of the pandemic. The calculations also take into account expected deaths that did not occur due to Covid restrictions, such as those from traffic accidents.
Calculating excess deaths globally is a complex task. Some countries closely tracked mortality data and provided it promptly to WHO. Others provided only partial data, and the agency had to use modeling to complete the picture. And then there are a large number of countries, including almost all of those in sub-Saharan Africa, that do not collect death data and for which statisticians have had to rely entirely on modelling.
Dr Asma of the WHO noted that nine out of 10 deaths in Africa and six out of 10 globally go unrecorded and more than half of the world’s countries do not collect exact causes of death. That means even the starting point for this kind of analysis is a “rough estimate,” she said. “We have to be humble about it and say we don’t know what we don’t know.”
To produce mortality estimates for countries with partial or no data on deaths, experts in the advisory group used statistical models and made predictions based on country-specific information such as containment measures, historical disease rates, temperature and demographics to assemble national figures and, from there, regional and global estimates.
Apart from India, there are other major countries where the data is also uncertain.
Russia’s health ministry had reported 300,000 Covid deaths by the end of 2021, and that’s the figure the government gave the WHO. But Russia’s national statistics agency, which is fairly independent of the government, found an excess death toll of more than a million people – a figure believed to be close to that of the WHO project. Russia objected to the figure, but made no effort to delay releasing the data, members of the group said.
China, where the pandemic began, does not publicly release mortality data, and some experts have raised questions about underreporting of deaths, particularly early in the outbreak. China has officially reported fewer than 5,000 deaths from the virus.
Although China has effectively kept case numbers well below most countries, it has done so in part thanks to some of the world’s strictest lockdowns – which have had their own impact on the public health. A die some studies to examine China’s excess mortality using internal data, conducted by a group of government researchers, showed deaths from heart disease and diabetes increased in Wuhan during that city’s two-month lockdown. The researchers said the increase was most likely due to the inability or reluctance to seek help in hospitals. They concluded that the overall death rate in Wuhan was about 50% higher than expected in the first quarter of 2020.
India’s efforts to block the release of the report make it clear that pandemic data is a sensitive issue for the Modi government. “This is an unusual step,” said Anand Krishnan, professor of community medicine at the Indian Institute of Medical Sciences in New Delhi, who also worked with the WHO to review the data. “I can’t remember a time when he did that in the past.”
Ariel Karlinsky, an Israeli economist who built and maintains the World Mortality Dataset and who has worked with the WHO on the figures, said they challenge governments when they show high excess deaths. “I think it makes a lot of sense that those in power fear those consequences.”
Viviane Wang contributed report.